Medicare Scams Busted!

Ninety-Four Arrested Over Medicare Scams Totaling $251 Million.
ABC World News (7/16, story 6, 2:05, Muir) reported on "hundreds of raids carried out this country" on Friday "in what's being called the biggest Medicare fraud bust in history. Doctors and nurses billing the American taxpayer for procedures that never happened, and clinics that don't even exist."
The CBS Evening News (7/16, story 3, 2:00, Couric) noted that "one way the government plans to pay for healthcare reform is by cracking down on Medicare fraud. ... Dozens of people have been arrested including doctors, patients, and clinic owners accused of scamming Medicare out of hundreds of millions of dollars."
The AP (7/17, Kennedy, Hays) reported, "Authorities said busts carried out this week in Miami, New York City, Detroit, Houston, and Baton Rouge, La., were the largest Medicare fraud takedown in history." The move also was "part of a massive overhaul in the way federal officials are preventing and prosecuting the crimes."
The Washington Post (7/18, Markon) noted, "The arrests came as Attorney General Eric H. Holder, Jr. and Health and Human Services Secretary Kathleen Sebelius held the first in a series of regional 'summits' on healthcare fraud prevention in Miami. The high-level attention marked the latest step in crackdown on fraud that the Obama administration has said is a key part of its agenda on healthcare reform."
The Miami Herald (7/17, Hiaasen) pointed out, "Experts say Medicare fraud in South Florida costs US taxpayers between $3 billion and $4 billion annually. It's predictable that Miami-Dade, Broward and Palm Beach counties would be the hotbed, and also the venue for one of every three federal healthcare fraud prosecutions."
CNN.com (7/16) reported, "The defendants are charged with conspiring to submit over $280 million in false claims to the federal healthcare program designed to aid the elderly." Sebelius said, "Today's arrests send a strong message that attempts to defraud Medicare will not be tolerated." According to the report, "charges include filing fraudulent claims for HIV/infusion services, home healthcare, physical therapy and durable medical equipment."
The New York Daily News (7/17, Marzulli) reported, "The feds busted a Medicare mill in Brooklyn where the elderly gathered in a 'kickback room' to collect payoffs under a Cold War-era poster warning them to keep their mouths shut." Brooklyn US Attorney Loretta Lynch said yesterday "that 15 people were arrested -- including an 82-year-old woman. Seven others are being sought in the $78 million scheme." The Wall Street Journal (7/17, Benoit, subscription required) and CQ HealthBeat (7/17, Adams, subscription required) also covered the story.

Senior Rebate Checks for Medication

The Modesto Bee -Jun. 28: Seniors who regularly take expensive medications are starting to receive $250 checks from the federal government in one of the first tangible benefits of national health care reform.The Medicare prescription drug rebate checks are part of the health care law signed by President Barack Obama in March. The package of benefits, consumer protections and insurance reforms promises major changes to health care in the next 10 years.
Seniors in Stanislaus County have received some of the 80,000 Medicare prescription drug rebates mailed thus far. There is no need for seniors to apply for the rebates. The patient's drug plan notifies Medicare when his or her drug costs exceed $2,830 for the year and the check goes out, said Frank Dotson, director of the county's Health Insurance Counseling and Advocacy Program."They don't need to do anything," Dotson said. "And they don't need to report the rebate if they feel it will affect their eligibility for any other benefits they have."Look out for scam artistsSeniors should beware of scam artists purporting to help them apply for or spend the rebate checks, he added. More than 380,000 Californians struggle with the coverage gap in Medicare prescription plans. It starts when their drug costs reach $2,830 and then they are expected to pay full price for drugs until out-of-pocket expenses total $4,550 for the year.Dotson said many Medicare recipients with limited incomes are not taking advantage of a prescription-drug subsidy program that predated health care reform.The benefit eliminates annual deductibles and the coverage gap, and sharply reduces co-payments for seniors with income of $1,354 a month and less than $12,510 in assets. For couples, the eligibility ceiling is income of $1,821 a month and $25,010 in assets.

Rate Increases are Studied Before Approval

The Los Angeles Times (7/1, Helfand) reports, "Embattled health insurer Anthem Blue Cross is reviving its plan to raise rates for tens of thousands of California policyholders, some of whom could see their premiums rise as much as 20%." The state's "largest for-profit insurer submitted new rates Wednesday amid pressure to scale back increases of as much as 39% that had provoked fury from consumers, lawmakers and even President Obama." Meanwhile, "California Insurance Commissioner Steve Poizner has hired an actuary to study rate filings submitted by Anthem, Aetna, Inc. and Blue Shield of California. Poizner announced Wednesday that he was making the filings public on the insurance department's website," and "a fourth insurer, Health Net, Inc., also will undergo additional scrutiny once it files new rates."
The San Francisco Chronicle (7/1, Colliver) notes that the proposed rates "would raise health premiums by an average of 14 percent, and as much as 20 percent, for thousands of California consumers."